Assessment Of Staff Nurse S Knowledge And Performance Regarding Triage

Original Article Egyptian Journal of Health Care, 2019 EJHC Vol.10 No.3
50
EJHC
Assessment of Staff Nurse's knowledge and Performance Regarding
Triage
Shaimaa Ahmed Mustafa, Samia Adam, Hemat Abd elazem
Nursing Administration Department - Faculty of Nursing, Ain Shams University
Abstract
Background: Emergency department is an integral unit in a hospital because it serve
large number of people so triage is needed to decrease overcrowding of Emergency department.
Triage is defined as the process of sorting a group of patient in a hospital. The study aimed
toassess emergency staff nurses' knowledge and performance regarding triage. Design: A
comparative descriptive design was used in carrying out the study. Setting: Emergency
departments of Ain Shams University Specialized Hospital affiliated to university hospitals and
Naser institute hospital affiliated to Ministry of health and population (MOHP). Subjects: 36
nurses from Ain shams university specialized hospital who worked in emergency department and
30 nurse from Naser institute hospital who worked in emergency department. Tool: the data
collection forms consisted of observational checklist to assess performance of nurses regarding
triage and questionnaire to assess knowledge of nurses regarding triage. Results: the results
showed that above half of the studied nurse had unsatisfactory knowledge regarding triage and
more than three quarter of them had inadequate performance regarding triage. Conclusion: the
studied nurse had unsatisfactory knowledge and inadequate performance regarding triage.
Recommendation: developed triage nurse roles and triage process in the curriculum of nursing
schools, nursing institutes and faculties of nursing, development of standards, specifications and
qualifications of triage nurse by the Ministry of Health and population, developed training
programs to all emergency health team personnel to determine the triage nurse qualifications,
role, and how to use triage process, developed the protocols and policies of emergency
department to facilitate the triage system and triage nurse work.
Key words:Triage, Triage nurse, knowledge, Performance.
Introduction
An emergency medicine is a field of
medical practice comprised of a unique set
of competencies required for the timely
evaluation, diagnosis, treatment and
disposition of all patients with injury, illness
and/or behavioral disorders requiring
expeditious care. These conditions are often
undifferentiated but are not limited to those
that are life threatening, acute and urgent.
This care is typically delivered in emergency
department (ED) (Canadian Association of
Emergency Physicians, 2016). So The ED
is an integral unit of a hospital and
experience of patients attending the ED
significantly influences the public image of
the hospital offering medical services
(Shaalan et al., 2008).

51
The primary mission of emergency
department is providing the best care
possible in the shortest time. But most
emergency departments do not have the
necessary and appropriate facilities for
referrals of patients (Weihai, 2012).
Overcrowding in emergency departments is
considered as a serious problem in all parts
of all the world . Sometimes patients wait
more than 60 minutes and this is especially
important when care is delayed, leading to
patients’ dissatisfaction (Golaghaei et al.,
2010).
The basic strategy to resolve this
problem is usage of a triage system or
prioritizing patients based on their clinical
status. So triage used in disaster or war is
brief assessment of victims that allows a
nurse to classify victims according to
severity of the injury, urgency of treatment,
and place for treatment and triage in
emergency department is defined as a brief
assessment of clients that allow nurse to
classify clients according to their need for
care and establishing priorities of care; the
type of illness or injury, the severity of
problem and resources available govern the
process(Silvestri, 2011).Triage also defined
as the method of prioritizing victims
according to their care needs, from most
severe to least injured o ill(Qureshi, and
Veenema, 2014): In the last century, due to
patient overcrowding and case mix, triage
has been widely used in civilian hospital
EDs to classify patients for management
priority.
In the last century, due to
overcrowding of patients in ED and case
mix, triage has been widely used in civilian
hospital EDs to classify patients for
treatment priority to manage life threatening
conditions as immediate (first priority),
potentially life, or limb threatening patients
as emergent (second priority), followed by
the less or possibly serious as urgent cases
(third priority) and, lastly, the non-urgent
patient (fourth priority). The ideal triage
system should be simple, and should satisfy
the hospital and patients’ needs. It should
prove to be sensitive (reliable and valid);
namely, priority I/II patients will be
admitted to critical care units within the
target time frame (Elgammal, 2015).
The purpose of triage in the (ED) is
to prioritize incoming large number of
patients who come to ED and to identify
those who cannot wait to be seen, so the
triage nurse must perform a brief, focused
assessment and assigns the patient a triage
acuity level, which is a proxy measure of
how long an individual patient can safely
wait for a medical screening examination
and treatment (American College of
Emergency Physicians, 2010).
The emergency nurse must initially
have all the core competencies to function
within the emergency department such as
(Basic Life Support, CPR and Pediatric
Advanced Life Support) and also she must
have completed a unique triage program.
For the first assessment as the patient
arrives, this nurse has the initial set of eyes
to identify the signs of a patient in distress.
For this reason, the emergency nurse making
triage decisions must have a diverse
knowledge base and strong physical
assessment skills (Susan, 2015).
There are many factors that affect
emergency nurses' performance. Those
factors may be job regulation related factors
or nurses related factors, so human resources
policies need to focus on overcoming the
factors that may affect negatively on the
nurses' performance. Also, it is important to
develop nurses' knowledge and skills, so
efforts should be directed towards enhancing
creativity among nurses and access to update
information and continuous educational
opportunities (Delucia et al., 2012).

Assessment of Staff Nurse's knowledge and Performance Regarding Triage
52
Significance of study
In order to ensure patient safety and
quality outcomes, hospitals must be certain
that every patient who presents to the
emergency department receives the right
care from the right provider at the right time.
This consequently will help emergency
nurses make sound clinical judgments at the
initial point of emergency care (Victoria's
Emergency Department, 2011).
Hence triage is a learned skill.
Emergency nurses spend many hours
learning to classify different illness and
injuries to ensure proper management of the
emergency (Stachy et al., 2011). Triage is a
highly important activity and solves many
problems of emergency services, such as
overcrowding by patients and improves the
quality of health outcomes cost-effectively.
Rising health care costs, poor quality of
health care costs, poor quality of care and
patient dissatisfaction are evident in settings
where emergency department are not
applying triage. Therefore triage needs to be
applied in all emergency departments
(Ahmed, 2011).
In emergency departments nurses
make triage but without triage knowledge
and defect in performing process of triage.
From my observation They are lacking in
knowledge and skills related to triage.If the
triage is activated in the emergency
department, will lead to save life of a lot of
patients using of minimum time. Therefore
this study will be conducted to assess the
knowledge and performance of emergency
nurse regarding to triage.
Aim of the study
This study aims to assess emergency
staff nurses' knowledge and performance
regarding triage through:
1. Assessing knowledge of emergency
staff nurses' regarding to triage.
2. Assessing emergency staff nurses'
performance regarding to triage.
Subjects and Methods
Research design and setting
A comparative descriptive design
was followed in carrying out this study at
the emergency departments in Ain Shams
University Specialized Hospital and Naser
Institute hospital.
Subjects:
The subject of this study included
two groups namely: staff nurses group and
jury group.
a-Staff nurses group included staff
nurse assigned to work in the emergency
departments in the aforementioned settings
as follow:
1- 35 out of 36 nurses from Ain Shams
University Specialized Hospital because
there was one nurse was in maternity
leave .
2- 30 nurses from Naser Institute hospital.
All nurses accepted to participate in the
study from both genders, with different
educational level and working in the
previous mentioned setting in emergency
department.
b-Jury group: this group included
expertsfrom faculties of nursing, commerce
and from ministry of health to test the
validity of the developed tools. The jury was
7experts, two of them professors of
administration at faculty of nursing, Cairo
university, one professor and one lecturers
of critical care nursing at faculty of nursing,
Cairo University, Two doctors from
ministry of health from emergent care unit
and one professor from disaster department
in faculty of commerce, Ain shams
university.

53
Tools of data collection:
The data were collected through
using three tools, namely knowledge
questionnaire sheet, nurse performance
observational checklist and oppenionnaire
sheet.
I. knowledge questionnaire sheet
(appendix. I):
To assess the knowledge of
emergency nurse regarding to triage, it was
written in Arabic language and prepared by
the researcher based on (Khalil, 2014,
Shaalan et al., 2008, Ahmed, 2011, Tony,
2009 and Iso papper from Elsalam
international hospital). It consisted of two
parts:-
First part: is concerned with the
nurses' characteristics as nurse's name, age,
gender, marital status, years of experience
and qualification.
Second part: it included 40 MCQ
questions to assess nurses' knowledge
regarding triage as follow.
Table (3): Dimension of knowledge questionnaire sheet
Dimension Number of items Example
1-Definition of triage. 1 Definition of triage .
2-Aim of triage. 2 Main aim of triage is
3-Triage process. 1 When a large group of clients arrive to
ER the first step of triage nurse is
4-Most common accidents with variable
clients and need emergency care.
1 Most common accidents with variable
clients and need emergency car are
5-Characteristic of effective triage
system.
1 Characteristic of effective triage
system is
6-First action of triage nurse for
evaluation of patients.
2 The importance 3 area which must be
evaluated y triage nurse are
7-Vocabulary used in triage system. 1 Vocabulary which used in triage
system are
8-Qualifications of triage nurse. 2 Triage nurse must to be able to
Dimension Number of items Example
9-Role of nurse in triage . 5 Role of triage nurse in evaluating
emergency patients
10-Color system used in triage. 4 Red color in triage refer to
11-Appropriate time for intervention in
every color of triage system.
3 Appropriate time of intervention for
red color in triage system is.
12-Applied use of colors in triage. 17 According to triage system, pregnant
mother with vaginal bleeding which
color is take
II. Nurses performance
observational checklist.
This checklist was developed by
the researcher based on (White et al.,
2013, Shaalan et al., 2008, Thelanetal.,
1998, and Ahmed, 2011) to assess
performance of emergency nurse
regarding triage. This checklist was
divided into two parts as the following:

54
First part: is concerned with the
nurses' characteristics as nurse's name,
age, gender, marital status, years of
experience and qualifications.
Second part:it contains 109 items
covering 5 basic phases of triage
(assessment of triage, nursing diagnosis,
nursing planning, nursing implementation
and nursing evaluation) described in the
following table.
Table (4): Dimension of performance observational checklist
Phases No of items Example
1-Assessment of triage room for availability of
 Equipment
5
Assess triage room for availability of blood
pressure apparatus .
 Supplies
13
Assess triage room for availability of airway
(all sizes).
 Medications.
11
Assess triage room for availability of KCL
ampoules.
 Records.
8
Assess triage room for availability of patients
identification.
 Patient's safety
8
Assess triage room for availability of sharp
containers.
Assessment of triage
 Patient identification.
7
Assess triage room for availability of patient's
safety precautions as bed side rails, upstairs.
 Subjective evaluation
3
Triage room assessment for availability of
electrical safety.
 Objective evaluation.
15
Triage room assessment for availability of
hazardous materials as sharp instruments.
2- Nursing diagnosis. 2 Make nursing diagnosis.
3-Nursing planning.
2
Planning for patient care according to patient's
need.
4-Nursing implementation :
 General care. 10 Arrange for all types of treatment to the case.
 Direct care. 20 Assist in cardiopulmonary resuscitation.
5-Evaluation 5 Evaluation for progress of triage cycle.
Oppenionnaire sheet: to test
validity of the developed knowledge
questionnaire sheet and observational
checklist by taking opinion of experts
from faculties of nursing and MOH
regarding the developed tools.
A pilot study was conducted to test
feasibility and applicability of the tools
used in this study. It was carried out on
10% of total study subjects (7 nurses).
Some modifications on tools were done
based on pilot study. The nurses who
included in the pilot study were excluded
from the main study group.
Field Work:
Upon securing official
permissions, the researcher met the study
subjects and explains the aim of study to
the nurses who agreed to participate in
the study prior to data collection. Data
collections took about 6 months started
from October 2014 to march 2015. Data
were collected by the researcher through
four days per week from 7.30am to
3.30pm about 8 hours per day (early
morning and afternoon shift) from Naser
institute hospital and Ain Shams
specialized hospital. The observational

55
checklist was used prior to administration
of the questionnaire to ensure the
maximal realistic observations of the
nurses' performance & minimize the
possibility of bias. The Nurses' practice
was assessed by the researcher at first
while they assess availability of
equipment, supplies, medications and
records of emergency room and then
while they caring for patients in
emergency through how they deal with
the patients, assessment, diagnosis,
planning, implementation and evaluation
of patients, how they deal with relatives
of patients, how they notifying supervisor
and physician about patient conditions.
The observational checklist observed for
every nurse for 3 times, Then, the self-
administered questionnaire sheet was
filled by the nurses in emergency unit and
it took about 30 minutes. The answers
were recorded by the nurses themselves.
Ethical consideration:
The research approval of protocol
was obtained from Scientific Research
Ethical Committee in Faculty of Nursing
at Ain Shams University before starting
the study. The researcher clarified the
objective and aim of the study to the
nurses included in the study.
The researcher assured maintaining
anonymity and confidentiality of the
subject data. Nurses were informed that
they allowed choosing to participate or
not in the study and that they had the
right to withdraw from the study at any
time without giving any reasons.
Statistical design:
Data entry and statistical analysis
were done using SPSS20.0 statistical
software package. Data were presented
using descriptive statistics in the form of
frequencies and percentages for
qualitative variables, and means and
standard deviations and medians for
qualitative variables. Qualitative
categorical variables were compared
using chi-square test. Whenever the
expected values in one or more of the
cells in a 2x2 tables was less than 5,
fisher exact test was used instead, in
larger than 2x2 cross tables, no test could
be applied whenever the expected value
in 10 % or more of the cells was less than
5 . Spearman rank correlation was used
for assessment of the interrelationships
among qualitative variables and ranked
ones. Statistical significance was
considered at p-value <0.05.

56
Result
Table (1): Socio-demographic characteristics of nurses in the study sample (n=65).
#
Frequency
Items
Hospital
46.2
30
Nasser institute hospital
53.8
35
Ain Shams Specialized hospital
Age
38.5
25
<30
61.5
40
30+
19.0±47.0
Range
30±7.3
Mean+SD
32.00
Median
Gender
20.0
13
Male
80.0
52
Female
Marital status
66.2
43
Married
33.8
22
Single
Experience years
26.2
17
5
10.8
7
5-10
63.1
41
10
Nursing qualification:
33.8
22
Secondary nursing diploma
7.7
5
Specialty diploma
29.2
19
Technical institute
27.7
18
Bachelor
1.6
1
Master
Table (1): shows socio-demographic characteristics of nurses in the study sample, the
table indicated that less than half (46.2%) of the studied nurses worked in Naser institute
hospital and more than half (53.8%) of the studied nurses worked in Ain Shams Specialized
Hospital, Regarding their age, more than half of them (61.5%) are over 30 years with mean
age 30.9± 3.7. Also highest number (80%) of them were female, more than half of them
(66.2%) were married, more than half of them (63.1%) had years of experience more than 10
years. In addition, more than quarter (33, 8%) of the studied nurses qualifications were
diploma while only one of them had master.

57
Table (2): Total knowledge of nurses regarding triage in the study sample.
Items Satisfactory Unsatisfactory
No % No %
Ain Shams University Specialized Hospital 20 57.1 15 42.9
Naser institute Hospital 21 70.0 9 30.0
Total knwoledge 24 37 41 63
X2-Test 1.15
P-Value 0.28
Table (2): displays total knowledge of nurses regarding triage in the study sample，it
summarizes that more than half of the studied nurse (63.1%) had unsatisfactory knowledge
regarding triage, while less than half of them (36.9 %) had satisfactory knowledge regarding
triage and also displays Comparison of nurse's knowledge regarding triage in the two of the
study hospitals, it is observed that there was insignificance difference between the studied
nurses of the two hospitals.
Table (3): total nurse's performance regarding triage among study nurse (n=65).
Percent.
Frequency.
*Practice
Assessment of triage room:
52.3
34
Equipment.
47.7
31
Supplies.
64.6
42
Medications.
50.8
33
Records.
52.3
34
Patient safety.
Total triage room assessment.
36.9
24
Adequate.
63.1
41
Inadequate
Assessment of triage.
44.6
29
Patient identification.
40.0
26
Subjective evaluation.
6.2
4
Objective evaluation.
12.3
8
Communication.
Total triage assessment.
24.6
16
Adequate.
75.4
49
Inadequate.
Nursing process.
4.6
3
Nursing diagnosis.
43.1
28
Nursing planning.
36.9
24
Implementation (general care).
9.2
6
Implementation (direct care).
32.3
21
evaluation.
Total nursing process.
12.3
8
Adequate.
87.7
57
Inadequate.
*Adequate practice at 60%

58
Table (3): describes total nurse's performance regarding triage among studied nurses,
it shows that more than half (63.1%) of the studied nurses had inadequate practice regarding
assessment of triage room, about three-quarters (75.4%) of them had inadequate practice
regarding assessment of triage also more than three-quarters (87.7%) of them had inadequate
practice regarding nursing process during care of patients.
Table (4): Relation between nurse's knowledge regarding triage and their
performance.
p-value
X2
-test
Performance
Knowledge. Inadequate
Adequate
%
NO.
%
NO
1.00
0.0
0.0
0
0.0
0
-Definition of triage.
0.56
Fisher
8.2
4
0.0
0
-Aim of triage.
0.007*
7.22
57.1
28
93.8
15
-Triage procedure.
1.00
Fisher
0.0
0
0.0
0
-Most common accident with variable
victims and need emergency care.
0.70
Fisher
14.3
7
18.8
3
-Characteristics of accurate triage system.
1.00
0.00
0.0
0
0.0
0
-First action of triage nurse for evaluation
of patients.
1.00
0.00
0.0
0
0.0
0
- Vocabulary used in triage system
0.60
Fisher
14.3
7
18.8
3
-Qualifications of triage nurse.
1.00
0.00
0.0
0
0.0
0
-Role of nurse in triage.
1.00
Fisher
12.2
6
12.5
2
-Color system used in triage.
1.00
Fisher
12.2
6
12.5
2
-Appropriate time for intervention in every
color of triage.
0.70
Fisher
14.3
7
18.8
3
-Applied use of colors in triage.
Total knowledge:
59.2
29
75.0
12
Satisfactory.
0.26
1.30
40.8
20
25.0
4
Unsatisfactory.
Table (4): displays the relation between nurse's knowledge regarding triage and their
performance, it shows that there was insignificance relation between the studied nurse's total
knowledge and performance regarding triage and subtitles except regarding triage procedure
however there was significance relation between knowledge and performance.
Table (5): Correlation between nurse's knowledge and performance of triage and
their personal characteristics.
Spearman's rank correlation coefficient
Practice scores
Knowledge scores
0.08
Practice
0.02
0.12
Age
0.01
0.03
Experience years
0.13
0.01-
Nursing qualification
Table (5): summarizes correlation between nurse's knowledge and performance of
triage and their personal characteristics, it demonstrates that no statistically significant

59
correlation between nurse's performance and knowledge, and between these and their age,
experience years, and nursing qualifications.
Discussion
The present study demonstrated
that less than half of the studied nurses
worked in Naser institute hospital and
more than half of the studied nurses
worked in Ain Shams Specialized
Hospital, their age was more than half of
them are over 30 years, This explains that
most of those nurses were elderly
graduated because more nursing
qualification of them was secondary
nursing diploma and they are old to
tolerate the nature of the work in EDs,
regarding their gender the current study
found that highest number of the study
subjects were female, this result may be
due to the most nursing schools were for
female and also in the past there was a
concept that is shame for the males to be
a nurse, this finding is consistent with that
of (Taha, 2007) who reported that most
of the nurses in Egypt were female, the
rational of these is concerning years of
experiences, the current study shows that
more than half of them their years of
experience was more than 10 years, the
researcher show that as result as all the
most newly graduated nurse travelling
abroad for great financial status, this
result is against (Maarouf, 2012)who
reported that more of nurses' experiences
years less than 10 yearsso most of nurses
were newly graduated and consequently
have few years of experience.
Regarding their qualifications, the
current study found that more than
quarter of the studied nurses
qualifications were diploma while only
one of them master, this result may be
due to the most nurses not complete the
studying in nursing institutes and
faculties of nursing as result of
difficulties in studying and also
difficulties for taking master degree,
Thisfinding is consistent with what was
reported by (Mohamed, 2009) who found
that all of the nurses under the study and
working were nursing diploma, these
reflect the need of improving educational
level of nurses who worked in critical
area such as EDs .
The current study illustrated that
generally more than half of the studied
nurses had unsatisfactory knowledge
regarding triage, while less than half of
them had satisfactory knowledge
regarding triage, these results may
attribute to insufficient training programs
regarding triage in nursing schools,
faculties of nursing and also in the
hospitals, This is agreed with, (Ahmed,
2011) where the study sample had
unsatisfactory knowledge regarding
triage, and also agreed with (Haghdust et
al., 2010) also reported that the nurses
which worked in Emergency room had
unsatisfactory knowledge regarding
triage.
Unsatisfactory knowledge
regarding triage may be due to lack of
orientation program for the newly nurses,
lack of job description of triage nurse,
perception of the nurses regarding their
role in saving life of emergent patient and
the physician in the responsible for life
saving of patient and the nurse is
assistance to physician, and also the
perception of the physician regarding role
of nurse in emergent situations is only
assistant and carrying out their orders.
Concerning the performance of
emergency nurses regarding triage, The
present study results demonstrated that
more than three-quarters of the studied
nurse had inadequate practice regarding

60
triage, This is may be attributed to lack of
nurses' knowledge which reflected on
their performance, inadequate in-service
training program, lack of qualification as
more than half of nurses were diploma
nurses, lack of number of nursing staff
and other job regulation factors. These
agreed with (Mirhaghi and Roudbari,
2010, Wahhabi, 2010 and Taheri et al.,
2005)whostated that performance of
emergency nurse's regarding triage was
inadequate.
In the current study results shows
that there was insignificant relation
between nurse's knowledge and their
personal characteristics, these may be due
to faulty choosing of right person in right
place, all nurses still in their place for
long time and insufficient training
programs regarding triage in nursing
schools, faculties of nursing and also in
the hospitals, this agree with (Ahmed,
2011) who reported that there was
insignificant difference between nurse's
knowledge regarding emergency triage
and their age. Also the current study was
in agreement with (Tweed and Tweed,
2008) who reported that there was
insignificant difference between nurse's
knowledge regarding emergency triage
and different level of experience and
qualifications. In contradictory with
(Blegen et al., 2001) who reported that
more experienced nurse provide higher
quality care. Also the current study
results were in agreement with
(Mirhaghi, and Roudbari, 2010) and
(Wahhabi, 2009),who mentioned that
emergency nurses had low level of
knowledge regarding triage, giving poor
treatments in EDs, so there are need of
giving sessions regarding triage and
importance of triage for patients, patient's
family, nurses and for community to
improve their knowledge regarding triage
. Concerning the relation between nurse's
performance regarding triage and their
nursing qualifications, the present study
showed that there was insignificant
relation between their performance and
their qualifications, these result may be
due to the state of unrefreshing of
knowledge for nurses and decrease of
training program regarding triage. These
disagree with (Ahmed, 2011)who showed
that the nurses with diploma and specialty
had adequate level of performance, but
the scores of nurses who are graduated of
technical institute were middle, and were
mostly statistically significant and higher
than those with diploma.(Youssef,
1999)who mentioned that the number of
years of education and training and also
the level of education affects positively
on the level of knowledge and
performance.
Regarding the relation between
nurse's performance regarding triage and
their experience years, the present study
showed that that there was insignificant
relation between their performance and
their experiences years, these may be due
to state of unrefreshing state of the nurses
and also spending all time of working in
the same departments and absence of
training program in hospitals. These
agreed with (Ahmed, 2011) who stated
that there was insignificant relation
between nurse's practice and their
experiences years. Also there was
insignificant relation between nurse's
practice regarding triage and their
personal characteristics, their work place,
their age, their gender and marital status.
As regard the relation between
nurse's knowledge regarding triage and
their practice, the present study illustrated
that there were insignificance relation
between the studied nurse's total
knowledge and practice regarding triage
and subtitles except regarding triage
process however there was significance
relation between knowledge and practice,
these result may be due to deficit of
training program regarding knowledge
and performance of triage, presence of
some instructions regarding triage but not
all nurses read these instruction,
unrefreshing state of the emergency

61
nurses and The majority of emergency
nurses have performed triage process
collaborated with a physician that may
help nurses to have a triage skill for
precise decisions at some circumstance,
These result agreed with(Brysiewicz,
2014)who stated that there are deficit and
significant relation in the triaging
knowledge and skills of nurses working
in the ED, so there is need for
establishing training programmers
regarding triage that will help to
establish and improve emergency nurses’
knowledge and skills on triaging.
Conclusion and Recommendation
Based on this study finding, it can
be concluded that about more than half of
the studied nurse had unsatisfactory
knowledge regarding triage, while less
than half of them had satisfactory
knowledge regarding triage. Furthermore
about more than three-quarters of the
studied nurses had inadequate
performance regarding triage, while less
than quarter of them had adequate
performance regarding triage.
Based on the study findings, the
following recommendations will be
provided to improve triage nurse's
knowledge and performance:
 Triage nurse roles and triage process
should be included in the curriculum of
nursing schools, nursing institutes and
faculties of nursing.
 Development of standards,
specifications and qualifications of
triage nurse by the Ministry of Health
and population.
 There is an urgent need for proper
infrastructure for ED to facilitate triage
process.
 There is an urgent need for availability
of appropriate supplies and equipment
in the emergency unit to facilitate the
triage implementation.
 There is a need for training programs to
all emergency health team personnel to
determine the triage nurse
qualifications, role, and how to use
triage process.
 The hospital management must have
insight about the importance of the
triage nurse role and the advantages of
triage process to put the appropriate
number of the nurse in emergency
department.
 The hospital manager must have the
protocols and policies of EDs to
facilitate the triage system and triage
nurse work.
 The role of triage nurse and triage
process must be announced to prevent
conflict between patient and patients
relatives and emergency health team.
 Planning for continuous training
program to emergency health team
regarding triage and triage process.
 There is a need for continuous
evaluation for triage nurse's knowledge
and performance.
 There is a need of further research
regarding effect of knowledge and
performance of triage on the percentage
of morbidity and mortality rate in ED.
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